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Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications

(2019) HEART RHYTHM. 16(7). p.1013-1020
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Abstract
BACKGROUND: The incidence of endoscopically detected esophageal lesions after pulmonary vein isolation (PVI) is as high as 18%. Intraesophageal temperature rise (ITR) during ablation is a predictor of esophageal injury. OBJECTIVE: The purpose of this study was to describe an ablation strategy aiming to enclose the pulmonary veins with contiguous, stable, and optimized radiofrequency applications (referred to as CLOSE-PVI). We evaluated esophageal and periesophageal injury with endoscopy in patients revealing ITR during CLOSE-PVI. METHODS: Eighty-five patients with ITR during CLOSE-PVI underwent endoscopy of the esophagus (with ultrasound in 38 patients). PVI consisted of contact force (CF)-guided encircling of the veins using 35-W applications, respecting strict criteria of intertag distance (<= 6 mm) and ablation index (AI; 550 arbitrary unit [au] anterior wall, 400 au posterior wall, 300 au if ITR >38.5 degrees C). RESULTS: Endoscopy was performed 9 +/- 4 days after PVI. At the posterior wall, median power was 35 W [interquartile range (IQR) 35-35], application time 18 +/- 5 seconds, CF 13 +/- 6g, and AI 403 +/- 38 au. A median of 5 applications [IQR 4-7] per patient over a length of 21.8 +/- 6.8 mm resulted in ITR >38.5 degrees C (median 39.9 degrees C, IQR 39.2 degrees C-41.2 degrees C, range 38.6 degrees C-50.0 degrees C). For these applications, median power was 35 W [IQR 30-35], application time 14 +/- 3 seconds, CF 12 +/- 5g, and AI 351 +/- 38 au. The incidence of esophageal erythema/erosion on endoscopy was 1 of 85 (1.2%) and of ulceration was 0 of 85 (0%). The incidence of mediastinal or esophageal injury on ultrasound was 0 of 38 (0%). CONCLUSION: The occurrence of esophageal or periesophageal injury after CLOSE-PVI is markedly low (1.2%). Absence of esophageal ulceration in patients with ITR suggests that this strategy of delivering contiguous, relatively high-power, and short-duration radiofrequency applications at the posterior wall is safe.
Keywords
Ablation index, Atrial fibrillation, Atrioesophageal fistula, Esophageal injury, High-power short-duration radiofrequency applications, Pulmonary vein isolation, PULMONARY VEIN ISOLATION, GENERAL-ANESTHESIA, LESIONS, INJURY, DAMAGE, RISK, PROBE, TIME

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MLA
Wolf, Michael, et al. “Endoscopic Evaluation of the Esophagus after Catheter Ablation of Atrial Fibrillation Using Contiguous and Optimized Radiofrequency Applications.” HEART RHYTHM, vol. 16, no. 7, 2019, pp. 1013–20.
APA
Wolf, M., El Haddad, M., De Wilde, V., Phlips, T., De Pooter, J., Almorad, A., … Duytschaever, M. (2019). Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications. HEART RHYTHM, 16(7), 1013–1020.
Chicago author-date
Wolf, Michael, Milad El Haddad, Vincent De Wilde, Thomas Phlips, Jan De Pooter, Alexandre Almorad, Teresa Strisciuglio, et al. 2019. “Endoscopic Evaluation of the Esophagus after Catheter Ablation of Atrial Fibrillation Using Contiguous and Optimized Radiofrequency Applications.” HEART RHYTHM 16 (7): 1013–20.
Chicago author-date (all authors)
Wolf, Michael, Milad El Haddad, Vincent De Wilde, Thomas Phlips, Jan De Pooter, Alexandre Almorad, Teresa Strisciuglio, Yves Vandekerckhove, René Tavernier, Harry J Crijns, Sébastien Knecht, and Mattias Duytschaever. 2019. “Endoscopic Evaluation of the Esophagus after Catheter Ablation of Atrial Fibrillation Using Contiguous and Optimized Radiofrequency Applications.” HEART RHYTHM 16 (7): 1013–1020.
Vancouver
1.
Wolf M, El Haddad M, De Wilde V, Phlips T, De Pooter J, Almorad A, et al. Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications. HEART RHYTHM. 2019;16(7):1013–20.
IEEE
[1]
M. Wolf et al., “Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications,” HEART RHYTHM, vol. 16, no. 7, pp. 1013–1020, 2019.
@article{8615680,
  abstract     = {BACKGROUND: The incidence of endoscopically detected esophageal lesions after pulmonary vein isolation (PVI) is as high as 18%. Intraesophageal temperature rise (ITR) during ablation is a predictor of esophageal injury. 
OBJECTIVE: The purpose of this study was to describe an ablation strategy aiming to enclose the pulmonary veins with contiguous, stable, and optimized radiofrequency applications (referred to as CLOSE-PVI). We evaluated esophageal and periesophageal injury with endoscopy in patients revealing ITR during CLOSE-PVI. 
METHODS: Eighty-five patients with ITR during CLOSE-PVI underwent endoscopy of the esophagus (with ultrasound in 38 patients). PVI consisted of contact force (CF)-guided encircling of the veins using 35-W applications, respecting strict criteria of intertag distance (<= 6 mm) and ablation index (AI; 550 arbitrary unit [au] anterior wall, 400 au posterior wall, 300 au if ITR >38.5 degrees C). 
RESULTS: Endoscopy was performed 9 +/- 4 days after PVI. At the posterior wall, median power was 35 W [interquartile range (IQR) 35-35], application time 18 +/- 5 seconds, CF 13 +/- 6g, and AI 403 +/- 38 au. A median of 5 applications [IQR 4-7] per patient over a length of 21.8 +/- 6.8 mm resulted in ITR >38.5 degrees C (median 39.9 degrees C, IQR 39.2 degrees C-41.2 degrees C, range 38.6 degrees C-50.0 degrees C). For these applications, median power was 35 W [IQR 30-35], application time 14 +/- 3 seconds, CF 12 +/- 5g, and AI 351 +/- 38 au. The incidence of esophageal erythema/erosion on endoscopy was 1 of 85 (1.2%) and of ulceration was 0 of 85 (0%). The incidence of mediastinal or esophageal injury on ultrasound was 0 of 38 (0%). 
CONCLUSION: The occurrence of esophageal or periesophageal injury after CLOSE-PVI is markedly low (1.2%). Absence of esophageal ulceration in patients with ITR suggests that this strategy of delivering contiguous, relatively high-power, and short-duration radiofrequency applications at the posterior wall is safe.},
  author       = {Wolf, Michael and El Haddad, Milad and De Wilde, Vincent and Phlips, Thomas and De Pooter, Jan and Almorad, Alexandre and Strisciuglio, Teresa and Vandekerckhove, Yves and Tavernier, René and Crijns, Harry J and Knecht, Sébastien and Duytschaever, Mattias},
  issn         = {1547-5271},
  journal      = {HEART RHYTHM},
  keywords     = {Ablation index,Atrial fibrillation,Atrioesophageal fistula,Esophageal injury,High-power short-duration radiofrequency applications,Pulmonary vein isolation,PULMONARY VEIN ISOLATION,GENERAL-ANESTHESIA,LESIONS,INJURY,DAMAGE,RISK,PROBE,TIME},
  language     = {eng},
  number       = {7},
  pages        = {1013--1020},
  title        = {Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications},
  url          = {http://dx.doi.org/10.1016/j.hrthm.2019.01.030},
  volume       = {16},
  year         = {2019},
}

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